CMII - Fracture Basics - Ortho Quiz

Which grade of muscle strength is this? Unable to move

0/5

Which grade of muscle strength is this? Slight movement

1/5

Which grade of muscle strength is this? Move in absence of gravity

2/5

Which grade of muscle strength is this? Move against gravity but not against resistance

3/5

Which grade of muscle strength is this? Move against resistance but less than the other limb

4/5

Which grade of muscle strength is this? Full, symmetric strength

5/5

How long should typically be enough time for a fx to heal?

6-8 weeks

A break of the 5th metacarpal bones of the hand near the knuckle. Occasionally it is used to refer to fractures of the 4th metacarpal as well. Symptoms include pain and a depressed knuckle. Classically, it occurs after a person hits an object with a closed fist.

Boxers fracture

Cortical disruption. Usually one side but can be both. PEDIATRICS

Buckle/Torus fracture

Impacted Distal Radius Fx. VOLAR Angulation (with the distal fragment pointed dorsally). Ulnar Styloid Fx. Occurs as a result of falling onto wrists in extension.

Colle's fracture

_______________ ________________ = ↑ pressure → ↓ vascular perfusion → tissue necrosis

Compartment Syndrome

Surgical Neck fracture with displacement of shaft anteriorly

Displaced surgical neck fracture

What is this? Rigid framework Levers for movement Protect internal organs Hematopoesis Reservoir for Calcium, Phosphorus, Magnesium, Sodium

Functions of Bone

Which grade of Gustilo Classification of Soft Tissue Status is this? <1cm wound

Grade I

Which grade of Gustilo Classification of Soft Tissue Status is this? >1cm wound with no significant soft tissue damage

Grade II

Which grade of Gustilo Classification of Soft Tissue Status is this? >1cm wound with soft tissue damage and the bone is often exposed

Grade IIIA

Which grade of Gustilo Classification of Soft Tissue Status is this? >1cm wound with significant soft tissue damage, bone exposed and periosteal stripping

Grade IIIB

Which grade of Gustilo Classification of Soft Tissue Status is this? >1cm wound with significant soft tissue damage, bone exposed and periosteal stripping, requires vessel repair to save the limb and "near amputation"

Grade IIIC

Mult longitudinal linear Fx of distal humerus Intra-articular Pediatric Elbow Fractures- BAD ! -High Risk for Complications -Consult Peds Ortho Pronto

Intercondylar fx of humerus

A fracture between the base and middle part of the fifth metatarsal of the foot. It results in pain near the midportion of the foot on the outside. "Transverse Fx Occuring in Zone 2 of the 5th MT"

Jones fracture

Torsional forces driven up the fibula cause a proximal fibula fracture Spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane. There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament of the ankle.

Massoneuve fracture

What is this called in the management of fractures: Know subtle injuries for all anatomic locations

Recognition

What is this called in the management of fractures: -Only with fractures with moderate or severe displacement -Closed vs Open manipulation -ORIF- open reduction - internal fixation

Reduction

What is this called in the management of fractures: -Stretching (ROM) and strengthening exercises -Increase muscle strength -Decrease joint stiffness

Rehabilitation

What is this called in the management of fractures: -Of reduction with splint, cast, or internal device

Retention

What is the mnemonic for Salter-Harris Classification?

SALTR S - slipped A - above L - lower T - through R - rammed

Which type of fx is this? Impacted, angulated fracture of the distal right radius. DORSAL angulation about 45 degrees. (and the distal fragment pointed volarly) Articular involvement? Results from falling onto flexed wrists.

Smith's (Reverse Colle's)

How would you describe this fx?

This is an AP X-ray of a comminuted, displaced distal femur fracture of a skeletally mature patient

How would you describe this fx?

This is an AP X-ray of a displaced (100%) spiral fracture of the L radius

Which type of Salter-Harris Classification is this? Transverse fracture through physis Physis width is increased Involves hypertrophic zone, NOT Growing zone....therefore, abnormality with growth is uncommon Fracture plane passes all the way through the growth plate, not involving bone Cannot occur if the growth plate is fused Good prognosis

Type I (slipped)

Which type of Salter-Harris Classification is this? Physis + Metaphysis *MOST COMMON (~75%) May cause minimal shortening Fracture passes across most of the growth plate and up through the metaphysis Good prognosis

Type II (above epiphysis)

Which type of Salter-Harris Classification is this? Physis + Epiphysis Splits epiphysis...therefore, damages reproductive layer of physis Prone to chronic disability Rarely has significant deformity Usually requires surgery Fracture plane passes some distance along with the growth plate and down through the epiphysis Poorer prognosis as the proliferative and reserve zones are interrupted

Type III (lower than physis)

Which type of Salter-Harris Classification is this? Metaphysis + Physis + Epiphysis Chronic Disability May cause premature bone fusion to cause deformity Usually requires surgery Intra-articular Fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis Poor prognosis as the proliferative and reserve zones are interrupted

Type IV (through the physis)

Which type of Salter-Harris Classification is this? Compression / Crush Fracture of Epiphyseal Plate Growth abnormality due to premature closure of physis Poor functional prognosis Uncommon (<1%) Crushing type injury does not displace the growth plate but damages it by direct compression Worst prognosis

Type V (rammed epiphysis)

Which order do you describe a fracture? For example, Angulated + Proximal + Surgical Neck + Humerus

Type or Pattern + Location + Bone

A fracture description that is described in degrees

angulated

Fracture _________________ describes a specific type of fracture displacement where the normal axis of the bone has been altered such that the distal portion of the bone points off in a different direction. It is described using words like: dorsal/palmar. varus/valgus

angulation

Pulselessness usually indicates _____________ trauma

arterial

The configuration of a fracture that is a portion of bone puled off from its origin

avulsion

A fracture description that is when a distal fragment longitudinally overlaps the proximal fragment

bayonetted

Paralysis occurs _____________ the compartment

below

What will you see these S&S with? swelling, pain which increases with movement, +/- visual deformity

bone fracture

X-RAYS MUST: -Include the entire ___________ -Include the __________ above and below the injury -Have at least _____ views which are 90 degrees to each other -Repeat any unacceptable images

bone; joint; 2

The extent of a fracture that is broken through one cortex

buckle/torus

Fractures of the shaft of a long bone that is characterized by bulging of the cortex. They result from trabecular compression due to an axial loading force along the long axis of the bone. Is this type a complete fx or incomplete?

buckle/torus fracture - incomplete

Severely angulated mid shaft radius and ulna fracture. (Approx 60 degree angulation) Is this an adult or child?

child

What does this describe in fracture healing? -Nontender to firm palpation -No motion at fracture site

clinical union

The extent of a fracture with 3+ pieces

comminuted

A break or splinter of the bone into more than two fragments. Since considerable force and energy is required to fragment bone, fractures of this degree occur after high-impact trauma such as in vehicular accidents. Is this type a complete fx or incomplete?

comminuted fracture - complete

1+ muscles with their nerves and vessels covered in fascia in closed area

compartment

The extent of a fracture with 2+ pieces

complete

The extent of a fracture that is an impaction of longitudinal forces

compression

Typically caused by a loss of bone mass (osteoporosis) that occurs as part of aging. A fall, cough, or lifting of a heavy object may cause a fracture of the back bones. Is this type a complete fx or incomplete?

compression fracture - incomplete

__________________ bone is the dense outer surface of bone that forms a protective layer around the internal cavity. This type of bone also known as compact bone makes up nearly 80% of skeletal mass and is imperative to body structure and weight bearing because of its high resistance to bending and torsion.

cortical

Do these factors increase or decrease stability in fracture healing? -Skeletal Maturity -Both-bone fractures of extremity -Comminuted, displaced pelvic fractures -Oblique fractures -Marked displacement -Unstable cervical or lumbar spine fractures -Comminuted and segmental fractures -Fractures involving a joint

decrease

Smokers, diabetics, autoimmune deficiency (RA), biologics, etc. may ___________ healing (get a good hx and medication list)

delay

What does this describe in fracture healing? -Not healed in expected period of time

delayed union

Treatment of Compartment Syndrome: -Early _____________ -Surgical ______________ *Delayed closure following decreased edema -Strict follow-up instructions *F/U if severe pain or _____________ -__________________ to reduce edema

detection; fasciotomy; paralysis; elevate

the shaft or central part of a long bone

diaphysis

A fracture description that is no longer in anatomic alignment and described in terms of percentage

displaced

The abnormal position of the distal fracture fragment in relation to the proximal bone. Types of fracture displacement include - angulation, rotation, change of bone length, and loss of alignment.

displacement of fractures

A fracture description that has a gap between fragments

distracted

the end part of a long bone, initially growing separately from the shaft.

epiphysis

A(n) ________________ fracture is a bone fracture in which it does not involve the joint

extraarticular

"a disruption in the continuity of bone that occurs as a result of a direct blow to the bone or an indirect force applied to the limb" - Greene

fracture

The extent of a fracture that is a bending force to immature bone

greenstick

A fracture in a young, soft bone in which the bone bends and breaks. Occur most often during infancy and childhood when bones are soft. The name is by analogy with which similarly breaks on the outside when bent. Is this type a complete fx or incomplete?

greenstick fracture - incomplete

The extent of a fracture that is nondisplaced

hairline

Also known as a stress fracture, this is a small crack or severe bruise within a bone. This injury is most common in athletes, especially athletes of sports that involve running and jumping. People with osteoporosis can also develop hairline fractures. Is this type a complete fx or incomplete?

hairline fracture - complete

The Salter-Harris Classification is only used for skeletally _________________ patients

immature

The extent of a fracture that is broken through one cortex and usually found in children

incomplete

Do these factors increase or decrease stability in fracture healing? -Skeletal Immaturity -Single bone fractures of extremity -Nondisplaced pelvic fractures -Transverse fractures -Presence of adjacent bone for support -Thoracic spine fractures

increase

A(n) ________________ fracture is a bone fracture in which the break crosses into the surface of a joint. This always results in damage to the cartilage. They have a higher risk for developing long-term complications, such as post-traumatic osteoarthritis.

intraarticular

What does this describe in fracture healing? -Healed in incorrect position

malunion

Between Diaphysis and Physis (Broad portion of bone adjacent to physis)

metaphysis

Early detection of compartment syndrome is important to prevent _________________ and loss of ____________________ function

necrosis; neurological

Is pulselessness a requirement to make a diagnosis of compartment syndrome?

no

A fracture description that is still in anatomic alignment

non-displaced

What does this describe in fracture healing? -Will not unite without intervention

non-union

The configuration of a fracture that is a diagonal break

oblique

The Gustilo Classification of Soft Tissue Status system classifies ____________ fractures based on the amount of energy, extent of soft tissue injury, extent of contamination, or arterial injury to determine the severity of the fracture. Grade I is the least severe, with Grade III the more severe open fractures.

open

Which P of compartment syndrome is this? -Out of proportion to injury -With Passive movement

pain

What are the 5 Ps of Compartment Syndrome?

pain, pressure, pulselessness, paresthesias, paralysis

Which P of compartment syndrome is this? Unable to contract affected muscles

paralysis

The extent of a fracture that is weakened by disease or malignancy

pathologic

A broken bone that is caused by a disease, rather than an injury. Some conditions weaken your bones, which makes them more likely to break. Everyday things, such as coughing, stepping out of a car, or bending over can fracture a bone that's been weakened by an illness. Is this type a complete fx or incomplete?

pathologic fracture - complete

Which P of compartment syndrome is this? > 30 mm Hg

pressure

For anyone with a significant ANKLE injury. Always palpate the knee and _____________ _____________ !!

proximal fibula

Which P of compartment syndrome is this? With Pallor Late finding

pulselessness

What does this describe in fracture healing? -Bridging bone trabeculae or fracture callus -No fracture line

radiographic union

The extent of a fracture with circumferential bone between 2 fractures

segmental

A fracture composed of at least two fracture lines that together isolate a segment of bone, usually a portion of the diaphysis of a long bone. Is this type a complete fx or incomplete?

segmental fracture - complete

The configuration of a fracture that is a twisting fracture

spiral

The configuration of a fracture that is a straight break

transverse

configuration of a fracture

transverse, oblique, etc.

Increased risk of compartment syndrome following _____________, involvement of long bones, crush injuries, systemic ____________, PVD

trauma; hypotension

What does this describe in fracture healing? -Fracture is healed when both clinically and radiographically united

union